| Objectives: We try to summarize the clinical data of intracranial papillary mucino us neoplasm(IPMN)and explore its diagnostic and treatment methods.Through compartments of the clinical efficacy of different two surgical methods,we try to evaluate the feasibility of open and robotic surgery in IPMN therapy.Methods: A retrospective analysis of January 2010 to February 2017 in our pancreatic center for pathological diagnosis of intraductal papillary tumor cases were analyzed and compared.The preoperative clinical data includes age,gender,disease duration,basic disease,ASA score and the intraoperative data includes operation time,blood loss,blood transfusion,anastomosis methods,spleen preservation or not.And postoperative pathological results such as tumor malignancy,size,margins.And finally data of postoperative recovery such as any complications,recovery of liquid and semi liquid diet time,removal time of drainage tube,postoperative hospital stay was collected.According to different surgical methods,the patients were divided into laparotomy group and robot surgery group.Results: A total of 205 patients were divided into laparotomy group and robotic surgery group according to different surgical methods.There were 114 patients(68.65%)with an average age of 60.39 ± 9.30 years in laparotomy group.There were 91 patients(62.64%)with an average age of 60.47 ± 9.27 years in robotic surgery group.The average operation time,blood loss and blood transfusion in laparotomy group was 246.89 ± 79.57 min,329.90 ± 269.65 ml,274.26 ± 473.21 ml respectively.The tumor was cut off with an average size of 3.49±2.08 cm.The incidence of postoperative complications was 42.10%(48/114),including 32.45%(37/114)of pancreatic fistula.The average removal time of drainage tube was 15.14 ± 7.14 days and the average postoperative hospital stay was 22.00 ± 13.44 days.1 death occurred in perioperative period.Postoperative pathology confirmed 29 cases of invasive IPMN.The average operation time,blood loss and blood transfusion in robotic surgery group was 207.01 ± 106.39 min,156.44 ± 204.93 ml,104.49 ± 304.47 ml respectively.The tumor was cut off with an average size of 2.51±1.33 cm.The incidence of postoperative complications was48.35 %(44/91),including 39.56%(36/91)of pancreatic fistula.The average extraction time of drainage tube was 12.55 ± 8.79 days and the average postoperative hospital stay was 22.43 ± 14.22 days.The 1,3 and 5-year tumor-free surviva l rate of open group were 98.82%,91.76% and 85.88% inrespectively.The 1,3 and 5-year tumor-free survival rate of robotic group were 100.00%,95.45% and 89.77% inrespective ly.The median tumor free survival time of open and robotic group were 59.00±11.16 months and 60.00±11.36 months respectively.The cumulative tumor free survival of benign IPMN cases in two groups shown no significant difference.Conclusion: The operation time of robotic surgery was shorter than that of open surgery(P=0.005),and the amount of blood loss and blood transfusion was less than that of open surgery(P < 0.001,P=0.003 respectively).The removal time of drainage tube in robotic surgery group was earlier than that of open surgery(P=0.035).There were no significa nt differences in postoperative complications such as pancreatic fistula,bleeding,reoperation and perioperative mortality.The results showed that robotic surgery is safe and feasible operation method.The cumulative tumor free survival of benign IPMN cases in two groups shown no significant difference.This result shows that the robot surgery could achieve the same curative effect as laparotomy. |
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